June 25, 2020

I have spent the last three plus hours reading deposition transcripts and my mind is reeling and my eyes are a little blurry so it’s time to leave the medico-legal world behind and return to the accidental plague diaries. Someone posed the question today as to what I would entitle my memoir, should I ever write one and I’ve decided, given all the weird, wonderful and serendipitous things that have occurred in my life combined with my writing best in short essay form, rather than long form, it would have to be called ‘Accidental Notes’. And now all my musician friends are groaning in unison. I’m sorry, I do like a good pun.

The news on Covid-19 over the last few days is absolutely devastating. It’s skyrocketing across the sunbelt – in Arizona, Texas, Florida, South Carolina. Not quite as much here but we’re not far behind. It’s as if all the pain and misery we endured throughout the spring through isolation and quarantine and flattening the curve simply had no effect. That’s not true. It had the desired effect. The curve did flatten, the exponential rates of spread did come down. It was obvious that we couldn’t all remain behind closed doors forever and some of us (including yours truly), due to the nature of our jobs really couldn’t do it at all. I’ve done my best to be careful, being mindful of my activities, and given up a lot of the things I enjoy in life to help my patients, my colleagues, and my fellow citizens survive and I don’t regret that.

Flattening the curve was never about defeating or ending the virus. It was about buying time to allow the tried and true public health measures to swing into place which could eventually tamp the pandemic down. What are those measures? Public education on what measures are necessary and why, social distancing, quarantine of the ill until they become non-infectious, and contact tracing of those exposed to separate them from the uninfected until the disease spread can be curbed. What did the federal government do with the time our sacrifices bought them? I’ll let you answer that question as my answer would likely contain a few too many expletives and bring the Facebook police down on my head.

When the public reached their limit for total societal quarantine (around about Memorial Day) and various political forces decided to politicize public health measures for momentary gains, states began to take divergent courses. Well governed states, following sound scientific public health measures, have been slowly reopening based on scientific data and good epidemiology. Poorly governed states more or less threw wide the gates and encouraged everything to return to the way it had been. You can probably guess where the virus is spreading like wildfire. As I have said repeatedly, the virus doesn’t care about your politics, your vacation plans, your comfort or anything else. It has one purpose and one purpose only, propagation and it will seek any change in your behavior patterns that it can exploit.

So, while the rest of the advanced world, by using everything learned about infectious disease epidemiology over the last two hundred years, brings their numbers down and the pandemic under control, the United States is merrily zooming the wrong way. I have a feeling the rest of the world is fairly close to placing a cordon sanitaire around the country to protect itself. For those unfamiliar with the concept, it’s a complete and total blockade around an infected locale. No one in or out. No foreign travel, no international business trips, trade severely hampered. Don’t think it can’t happen or that America, with its naive belief in American Exceptionalism is immune from the social forces of the rest of the world.

From what I can tell, there’s really only one way to bring the pandemic under control, and that’s for the American citizenry to change the government to one that will actually act on basic public health measures that protect its citizens. There’s a chance to do that in a few months. We’ll see if they are able. In the meantime, from what I can tell, older people will continue to protect themselves and younger people, believing themselves in no specific danger, will not. the problem is that a certain percentage of younger people are also falling deathly ill. It may be a smaller percentage than of older people, but it’s still significant. There’s also the issue of long term effects on those who don’t actually die. Some studies are suggesting that even young and healthy are having serious compromises of lung function which will likely play havoc on them as they age into middle and then older age.

With a failed societal response, we all have to do what little we can do. Wear our masks (it does help reduce transmission significantly when we all do that – and stop with the ridiculousness about HIPAA and the ADA and the nonsense about how you can’t breathe or you’re going to get carbon dioxide poisoning or any of the other pieces of garbage I’ve seen floating around), wash our hands, stay home when we can. It isn’t fun but they’re what will buy us the time to work on better societal solutions.